Active NPI
Matthew Niemiera
- Physical Therapist
- Denton, TX
National Provider Identifier
1720023336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1131407
- Practice address
- 733 Fort Worth Dr Ste 102
Denton, TX 76201-7100 - Phone
- (940) 595-0566
- Fax
- (940) 387-7275
- NPI assigned
- Jun 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1131407 | TX | Primary |
| Physical Therapy Clinic/Center | 261QP2000X | 1131407 | TX |
Addresses
Primary practice location
733 Fort Worth Dr Ste 102
Denton, TX 76201-7100
Mailing address
PO Box 634
Justin, TX 76247-0634
Phone (940) 595-0566
Other practice location 1
509 E Byron Nelson Blvd Ste B
Roanoke, TX 76262-6183
Phone (940) 595-0566
Other practice location 2
630 N Kimball Ave Ste 100
Southlake, TX 76092-6886
Phone (940) 595-0566
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T6036 | Other | TX | BCBS |
| 160835802 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1659312000000",
"number": "1720023336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 634",
"city": "JUSTIN",
"state": "TX",
"postal_code": "762470634",
"telephone_number": "940-595-0566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "733 FORT WORTH DR STE 102",
"city": "DENTON",
"state": "TX",
"postal_code": "762017100",
"telephone_number": "940-595-0566",
"fax_number": "940-387-7275"
}
],
"practiceLocations": [
{
"address_1": "509 E Byron Nelson Blvd Ste B",
"address_purpose": "LOCATION",
"city": "Roanoke",
"state": "TX",
"postal_code": "762626183",
"country_code": "US",
"telephone_number": "940-595-0566",
"fax_number": "940-387-7275",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "630 N Kimball Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Southlake",
"state": "TX",
"postal_code": "760926886",
"country_code": "US",
"telephone_number": "940-595-0566",
"fax_number": "940-387-7275",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NIEMIERA",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-18",
"last_updated": "2022-08-01",
"certification_date": "2022-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1131407",
"primary": true
},
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": "TX",
"license": "1131407",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8T6036",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160835802",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.